INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
The treatment of
cranio-maxillofacial deformities poses a great
challenge to the modern maxillofacial surgeons and
dentofa...
Treatment modalities available are either Functional
appliances in the growing years or Orthognathic
surgery.

www.indiand...
The latest technique for combating the same is a
procedure termed
“Distraction Osteogenesis”

www.indiandentalacademy.com


Preferences over orthognathic surgery



Biological basis of DO



Various devices for DO



Indications & contraind...
Distraction Osteogenesis is a biological process of new
bone formation between surfaces of bone segments
gradually separat...


Ilizarov Effects



Ilizarov principles of DO



Sequential periods of DO
- corticotomy
- latency
- distraction
- con...



Tension – stress effect
Influence of blood supply & mechanical load

www.indiandentalacademy.com


Osteotomy of the bone site with minimal periosteal stripping.



Latency period: 3, 5, or 7 days, depending on the sur...
 Sequences

osteotomy

of DO

latency
distraction
www.indiandentalacademy.com

consolidation
www.indiandentalacademy.com
 Extraoral

- Unidirectional

www.indiandentalacademy.com
 Bidirectional

 Multidirectional

www.indiandentalacademy.com
 Intraoral


1.

Wangerin's vertical mandibular distraction
device
(Medicon eG, Tuttlingen, Germany) before (left)

www....


2.

Tooth-borne ROD distraction device
(Oral Osteodistraction, L.P.,
Buffalo Grove, IL, USA)
disassembled (left) and as...
 3.

DynaForm Intraoral Distractor
(Stryker Leibinger, Kalamazoo,
MI, USA) with two types of arm

www.indiandentalacademy...
 4.

Diner and Vazquez's mandibular body (left)
and mandibular ramus (right) distractors
(Stryker Leibinger, Kalamazoo, M...


Age



Greater advancements



Histeogenesis



No Need of bone grafts



Less surgical dissection



Can be done ...


Time consuming



Socially not acceptable



Proper monitoring and maintenance of the device is required.

www.indian...
 Severe retrognathia associated with a syndrome especially in

infants and children who are not candidates for traditiona...


Mandibular hypoplasia due to trauma and/or ankylosis of the
temporomandibular joint



Mandibular continuity defects r...
 Patients who are unable or unwilling to comply with the

distraction schedule are not ideal candidates for this procedur...


Distraction osteogenesis of the mandible may be used on
patients who have received prior radiation treatment.
However, ...


Preoperative planning & Diagnosis
- radiographs
- cephalometric analysis
- stereolithographic models



Treatment

www...


Areas of applications –
- Maxilla
- Mandible

ramus, body, symphysis

- Obstructive sleep apnoea
- TMJ
- Alveolar regio...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
 Mandibular

lengthening & widening

www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
 In

the region of symphysis

www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com


Presence of Scar tissue



Soft tissue abnormalities



Difficulty in mobilizing maxilla



Difficulty in control of...


Regenerate malformation



Axial deviation



Soft tissue over stretching



Blood vessels



Peripheral nerves


...


Bone necrosis



Buckling or bending



Pin loosening



Scar formation



Infection



Pain

www.indiandentalacad...


Does not correct underlying growth disturbances.



Second procedures may still be required.



Mineral content & rad...


Effects of distraction on growth



Limits of DO



Effects of distraction on eruption and movement of teeth



Long...


Refinements in the distraction protocol



Improvements in distraction devices



Enhancement of regenerate maturatio...


Distraction osteogenesis has proven to be an extremely versatile
and superior method for the correction of dentofacial
...


Acta Stomat Croat 2002; 103-105



American Journal of Orthodontics and Dentofacial Orthopedics.
Volume 116, Number 3
...
www.indiandentalacademy.com
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Distraction osteogenesis /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Distraction osteogenesis /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. The treatment of cranio-maxillofacial deformities poses a great challenge to the modern maxillofacial surgeons and dentofacial orthopeditians… www.indiandentalacademy.com
  3. 3. Treatment modalities available are either Functional appliances in the growing years or Orthognathic surgery. www.indiandentalacademy.com
  4. 4. The latest technique for combating the same is a procedure termed “Distraction Osteogenesis” www.indiandentalacademy.com
  5. 5.  Preferences over orthognathic surgery  Biological basis of DO  Various devices for DO  Indications & contraindications of DO  Disadvantages of DO  Surgical applications of DO  Unsolved issues of DO  Future directions of DO  Complications of DO  Limitations of DO www.indiandentalacademy.com
  6. 6. Distraction Osteogenesis is a biological process of new bone formation between surfaces of bone segments gradually separated by incremental traction. Cope – AJO, 1999 www.indiandentalacademy.com
  7. 7.  Ilizarov Effects  Ilizarov principles of DO  Sequential periods of DO - corticotomy - latency - distraction - consolidation www.indiandentalacademy.com
  8. 8.   Tension – stress effect Influence of blood supply & mechanical load www.indiandentalacademy.com
  9. 9.  Osteotomy of the bone site with minimal periosteal stripping.  Latency period: 3, 5, or 7 days, depending on the surgical site.  Distraction rate: 1.0 mm per day (0.5–2.0 mm)  Distraction rhythm: continuous force application is best, yet device activation bid is more practical and allows for better patient compliance  Consolidation: until a cortical outline can be seen radiographically across the distraction gap, usually 6 weeks www.indiandentalacademy.com
  10. 10.  Sequences osteotomy of DO latency distraction www.indiandentalacademy.com consolidation
  11. 11. www.indiandentalacademy.com
  12. 12.  Extraoral - Unidirectional www.indiandentalacademy.com
  13. 13.  Bidirectional  Multidirectional www.indiandentalacademy.com
  14. 14.  Intraoral  1. Wangerin's vertical mandibular distraction device (Medicon eG, Tuttlingen, Germany) before (left) www.indiandentalacademy.com
  15. 15.  2. Tooth-borne ROD distraction device (Oral Osteodistraction, L.P., Buffalo Grove, IL, USA) disassembled (left) and assembled (right). www.indiandentalacademy.com
  16. 16.  3. DynaForm Intraoral Distractor (Stryker Leibinger, Kalamazoo, MI, USA) with two types of arm www.indiandentalacademy.com
  17. 17.  4. Diner and Vazquez's mandibular body (left) and mandibular ramus (right) distractors (Stryker Leibinger, Kalamazoo, MI, USA). www.indiandentalacademy.com
  18. 18.  Age  Greater advancements  Histeogenesis  No Need of bone grafts  Less surgical dissection  Can be done for transverse discripancies  Healing by primary intention  Minimal skeletal relapse www.indiandentalacademy.com
  19. 19.  Time consuming  Socially not acceptable  Proper monitoring and maintenance of the device is required. www.indiandentalacademy.com
  20. 20.  Severe retrognathia associated with a syndrome especially in infants and children who are not candidates for traditional osteotomies.  Unilateral hypoplasia of the mandible (eg, hemifacial microsomia).  Nonsyndromic mandibular hypoplasia associated with a dental malocclusion  Mandibular transverse deficiency associated with a dental malocclusion and dental crowding. www.indiandentalacademy.com
  21. 21.  Mandibular hypoplasia due to trauma and/or ankylosis of the temporomandibular joint  Mandibular continuity defects resulting from excision of tumors and/or aggressive developmental cysts  Shortened vertical height of the alveolar bone www.indiandentalacademy.com
  22. 22.  Patients who are unable or unwilling to comply with the distraction schedule are not ideal candidates for this procedure.  Mandibular distraction osteogenesis has been performed on infants as young as nine days old, but more difficulty is encountered when dealing with small fragile bones in the placement of the distraction device.  Adequate bone stock must be available to accept the device and to provide adequate surface area of the osteotomy sites for regeneration. www.indiandentalacademy.com
  23. 23.  Distraction osteogenesis of the mandible may be used on patients who have received prior radiation treatment. However, this procedure must be performed with caution because these patients are more likely to develop complications and to experience delays in wound healing.  In older patients, the decreased number of mesenchymal stem cells may impair bone healing at the distraction site. www.indiandentalacademy.com
  24. 24.  Preoperative planning & Diagnosis - radiographs - cephalometric analysis - stereolithographic models  Treatment www.indiandentalacademy.com
  25. 25.  Areas of applications – - Maxilla - Mandible ramus, body, symphysis - Obstructive sleep apnoea - TMJ - Alveolar region - Clefts www.indiandentalacademy.com
  26. 26. www.indiandentalacademy.com
  27. 27. www.indiandentalacademy.com
  28. 28. www.indiandentalacademy.com
  29. 29. www.indiandentalacademy.com
  30. 30. www.indiandentalacademy.com
  31. 31. www.indiandentalacademy.com
  32. 32. www.indiandentalacademy.com
  33. 33. www.indiandentalacademy.com
  34. 34. www.indiandentalacademy.com
  35. 35. www.indiandentalacademy.com
  36. 36. www.indiandentalacademy.com
  37. 37. www.indiandentalacademy.com
  38. 38. www.indiandentalacademy.com
  39. 39.  Mandibular lengthening & widening www.indiandentalacademy.com
  40. 40. www.indiandentalacademy.com
  41. 41. www.indiandentalacademy.com
  42. 42. www.indiandentalacademy.com
  43. 43. www.indiandentalacademy.com
  44. 44. www.indiandentalacademy.com
  45. 45.  In the region of symphysis www.indiandentalacademy.com
  46. 46. www.indiandentalacademy.com
  47. 47. www.indiandentalacademy.com
  48. 48. www.indiandentalacademy.com
  49. 49. www.indiandentalacademy.com
  50. 50. www.indiandentalacademy.com
  51. 51.  Presence of Scar tissue  Soft tissue abnormalities  Difficulty in mobilizing maxilla  Difficulty in control of bone segments  Associated 3D deformity, Nasal deformity  Presence of serve dental arch abnormality  Maxilla – mandibular skeletal & dental relationship  Oral hygiene status  Quality & Quantity of bone  General Medical condition www.indiandentalacademy.com
  52. 52.  Regenerate malformation  Axial deviation  Soft tissue over stretching  Blood vessels  Peripheral nerves  Skeletal muscles  Cystic degeneration www.indiandentalacademy.com
  53. 53.  Bone necrosis  Buckling or bending  Pin loosening  Scar formation  Infection  Pain www.indiandentalacademy.com
  54. 54.  Does not correct underlying growth disturbances.  Second procedures may still be required.  Mineral content & radio density of the generated tissue is less than normal  Functional level is also less  Distractor devices are too bulky – refinement is required.  Clinical experience and expertise is still limited.  Hospitalization and associated complications are unavoidable.  Certain degree of Relapse still takes place. www.indiandentalacademy.com
  55. 55.  Effects of distraction on growth  Limits of DO  Effects of distraction on eruption and movement of teeth  Long term stability of regenerate bone www.indiandentalacademy.com
  56. 56.  Refinements in the distraction protocol  Improvements in distraction devices  Enhancement of regenerate maturation www.indiandentalacademy.com
  57. 57.  Distraction osteogenesis has proven to be an extremely versatile and superior method for the correction of dentofacial deficiencies as well as deficiencies in other parts of the body. But, a detailed study needs to be carried out to establish the critical parameters. In all, craniofacial distraction osteogenesis may perhaps be the answer, the solution to bring out smiles in those affected by various malformations. www.indiandentalacademy.com
  58. 58.  Acta Stomat Croat 2002; 103-105  American Journal of Orthodontics and Dentofacial Orthopedics. Volume 116, Number 3  American Journal of Orthodontics and Dentofacial Orthopedics. Volume 115, Number 1  MJAFI 2005; 61 : 345-347  J Oral Maxillofac Surg 60:496-501, 2002  Distraction Osteogenesis of The Facial Skeleton By Bell & Guerrero www.indiandentalacademy.com
  59. 59. www.indiandentalacademy.com

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